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June 02, 2007 at 10:21 PM
A federal judge has approved a previously announced agreement that should help many different Blue Cross and Blue Shield plans resolve litigation with 900,000 doctors, lawyers for the doctors say.
U.S. District Court Judge Federico Moreno today approved a settlement agreement that lawyers for the doctors negotiated with the Blue Cross and Blue Shield Association, Chicago, and a group of more than 20 Blues plans, lawyers for the doctors report.
The BCBSA and the participating Blues plans have agreed to pay about $128 million into a general settlement fund for the plaintiffs.
Under the terms of the agreement, the participating Blues also are promising to:
- Ensure the payment of valid clean claims within 15 days for electronic submitted claims and 30 days for paper claims.
- Give physicians fee schedules.
- Pay for the cost of recommended vaccines and injectables and for the administration of such vaccines and injectables.
- Use clinical guidelines that are based on credible scientific evidence published in peer-reviewed medical literature when making medical necessity determinations.
In the late 1990s, lawyers filed a wave of suits accusing the settling plans and other health carriers of working together to lower and delay payments to doctors in unreasonable ways.
In 2003, the courts consolidated the litigation against the Blues plans, now known as the Thomas-Love litigation, in Miami under U.S. District Court Judge Federico Moreno.
The only large managed care company still challenging the litigation consolidated in Miami is a unit of UnitedHealth Group Inc., Minnetonka, Minn., to the lawyers representing the doctors.
The group of settling Blues plans includes:
- Blue Cross and Blue Shield of Alabama.
- CareFirst Inc. and CareFirst of Maryland Inc.
- Group Hospitalization and Medical Services Inc.
- Blue Cross and Blue Shield of Florida.
- Hawaii Medical Service Association.
- Health Care Service Corp.
- Wellmark Inc., along with Wellmark Blue Cross and Blue Shield of Iowa and Wellmark of South Dakota Inc.
